Acromioclavicular joint fixation technique

ABSTRACT

A reconstruction system and method for fixation of bone to bone, or soft tissue to bone. The reconstruction system comprises two fixation devices (for example, two buttons) joined by a continuous loop of flexible material. Each button is provided with at least one opening that allows the passage of the flexible material. The button may be formed, for example, of metal, PEEK or PLLA. The flexible material may be FiberWire® suture.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. application Ser. No.11/482,038, filed Jul. 7, 2006, which claims the benefit of U.S.Provisional Application No. 60/697,125, filed Jul. 7, 2005. Thisapplication also claims the benefit of U.S. Provisional Application No.60/783,869, filed Mar. 21, 2006. The entire disclosures of these priorapplications are incorporated by reference herein.

FIELD OF THE INVENTION

The present invention relates to the field of surgery and, inparticular, to a joint or ligament reconstruction technique andassociated fixation and reconstruction device.

BACKGROUND OF THE INVENTION

Disruption of ligaments, such as the coracoclavicular ligament, is acommon occurrence. In many cases, the injury can be treatedconservatively and the only residual problem is that of a mild cosmeticdeformity. Several groups of patients, however, do not tolerate theinjury well. If the joint is reduced acutely and held reduced during thehearing phase, the native ligaments will heal restoring the stability ofthe joint.

BRIEF SUMMARY OF THE INVENTION

The present invention provides a technique and reconstruction system forfixation of bone to bone, or soft tissue to bone. The reconstructionsystem of the present invention comprises two fixation devices (forexample, two buttons) joined by a continuous loop of flexible material.Each button is provided with at least one opening that allows thepassage of the flexible material. The button may be formed, for example,of metal, PEEK or PLLA. The flexible material may be suture such asFiberWire® suture, sold by Arthrex, Inc. of Naples, Fla.

The present invention also provides a method of fixation of bone tobone, or soft tissue to bone. The method of the present inventioncomprises the steps of: (i) providing a tunnel through a first bone anda second bone; (ii) providing a two button/suture loop constructincluding two buttons joined by a continuous loop of flexible materialin the vicinity of the bones; (iii) advancing one of the two buttonsthrough the first and second bones, until it exits the second bone; and(iv) advancing the other button to the surface of the first bone.

These and other features and advantages of the invention will be moreapparent from the following detailed description that is provided inconnection with the accompanying drawings and illustrated exemplaryembodiments of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1-7 illustrate subsequent steps of a method of jointreconstruction in accordance with an exemplary embodiment of the presentinvention.

FIG. 8 is a schematic illustration of a fixation and reconstructiondevice of the present invention.

FIGS. 9 a and 9 b illustrate exemplary embodiments of one member of thefixation device shown in FIG. 8.

FIG. 10 illustrates an embodiment of the other member of the fixationdevice shown in FIG. 8.

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides a technique and reconstruction system forfixation of bone to bone, or soft tissue to bone. The reconstructionsystem (TightRope system) of the present invention comprises twofixation devices (for example, two buttons) having various geometries(for example, circular or oblong) and being joined by a continuous loopof suture. Each button is provided with at least one opening (preferablytwo openings) that allow the passage of suture. The button may beformed, for example, of metal, PEEK or PLLA. The suture may beFiberWire® suture, sold by Arthrex, Inc. of Naples, Fla.

The present invention also provides a method for fixation of bone tobone, or soft tissue to bone. The method of the present inventioncomprises the steps of: (i) providing a first hole through a first boneand a second hole through a second bone of a joint; (ii) providing a twobutton/suture loop construct (TightRope) including two buttons joined bya continuous loop of flexible material in the vicinity of the joint;(iii) advancing one of the two buttons through the holes in the firstand second bones, until it exits the second bone; and (iv) advancing theother button to the surface of the first bone.

According to an exemplary embodiment, the present invention provides amethod of acromioclavicular (AC) joint reconstruction, comprising thesteps of: (i) providing a hole through the clavicle and the coracoid;(ii) providing a two button/suture loop construct (including two buttonsjoined by a continuous loop of suture) in the vicinity of the AC joint;(iii) advancing one of the two buttons through the hole in the clavicleand the coracoid until it exits the coracoid base; and (iv) advancingthe other button to the surface of the clavicle.

According to another exemplary embodiment, and as described in moredetail below, the acromioclavicular (AC) joint reconstruction techniqueof the present invention comprises the steps of: (i) drilling a hole ofabout 4 mm through the clavicle and the coracoid by using a C-Ringadapteur guide and a cannulated drill; (ii) leaving the cannulated drillin the clavicle and the coracoid; (iii) advancing a suture passing wirethrough the cannulated drill and subsequently removing the drill; (iv)inserting two traction sutures from the oblong button of the fixationsystem of the invention through the wire loop of the suture passingwire; (v) pulling the suture passing wire to retrieve the two tractionsutures out of the anterior/inferior cannula; (vi) advancing the oblongbutton through the clavicle and the coracoid until it exits the coracoidbase, and pulling on each of the traction sutures of the oblong buttonto flip the button onto the underside of the coracoid base, to securethe oblong button; (vii) pulling on suture tails of the round button, toadvance the round button down to the surface of the clavicle; and (viii)tying the sutures to stabilize the acromioclavicular joint.

The method of the present invention has applications to joint andligament reconstruction. Particular applications relate toacromioclavicular joint reconstructions, where the method of the presentinvention provides a simple, reproducible, minimally invasive techniquefor acute acromioclavicular joint stabilization which enables a rapidreturn to activity for the acute injury. The technique is indicated foracute acromioclavicular joint dislocation (Rockwood type III to VI) ofless than one month duration.

Referring now to the drawings where like elements are designated by likereference numerals, FIGS. 1-7 illustrate a human joint 99 undergoingjoint reconstruction according to an embodiment of the presentinvention. FIGS. 8-10 illustrate a fixation system 100 of the inventionwhich, as described below, is inserted into a drilled hole through thejoint bones using a single suture strand to obtain the repair structureof FIG. 7.

For simplicity, and according to exemplary embodiments only, theinvention will be described below with reference to a particularembodiment, wherein the joint 99 is an acromioclavicular (AC) joint 99of the human shoulder comprising clavicle 10 and coracoid 20 andundergoing acromioclavicular (AC) joint reconstruction according to anembodiment of the present invention. Also for simplicity, reference tothe fixation system 100 of FIGS. 8-10 will be made in this applicationas to the acromioclavicular reconstruction or fixation system 100 (whichis inserted into a drilled hole through the clavicle and the coracoidusing a single suture strand to obtain the repair structure of FIG. 7).However, the invention is not limited to this particularacromioclavicular (AC) joint fixation system, but contemplatesreconstruction and/or fixation systems for any structures (bone,cartilage, soft tissue, etc.) that need to be stabilized, fixated and/orreconstructed.

As illustrated in FIG. 8, the fixation system 100 of the presentinvention comprises two buttons 101, 102 joined by a continuous loop ofsuture 110. The buttons may have various configurations and dimensionsand may be similar to, or different from, each other. For example, thebuttons may be circular, oblong, rectangular or parallelepipedal, amongmany other configurations. Preferably, one button is circular and theother button is oblong. In the exemplary embodiment illustrated in FIG.8, button 101 is circular and button 102 is oblong.

Button 102 is illustrated in FIG. 9a as having a body 112 provided withfirst and second apertures 114, 116. The button 102 is preferably formedfrom titanium or stainless steel, although any other suitable materialcould be used, in particular any suitable bioabsorbable material. In theembodiment shown in FIG. 9 a, the first aperture 114 and the secondaperture 116 are oblong in shape, the longitudinal mid-line of each ofthe first and second apertures 114, 116 being located substantiallyabout a longitudinal mid-line of the button 102. Preferably, the button102 has a length of about 9 mm to about 20 mm, more preferably of about12 mm to about 15 mm, and a width that is less than about 1 mm narrowerthan the width of the drill holes through which the button is insertedand subsequently passed through. Preferably, button 102 is very smallhaving a width that allows it to pass through a 3 mm cortical pin holewithout over drilling, which in turn saves time and preserves bone.

FIG. 9 b illustrates yet another embodiment of a button of the presentinvention, indicated as 202. In the illustrated alternative embodiment,the button 202 is about 9.0 mm in length by about 3.5 mm in width, witha thickness of about 1.5 mm. The button 202 has first and secondapertures 214 and 216, respectively, provided within body 212. In theillustrated alternative embodiment, each of the apertures 214, 216 aretriangular in shape, the respective apices 215 being directed away fromeach other and being located substantially about a longitudinal mid-lineof the button 202. Button 202 may be formed, for example, of metals suchas titanium, titanium alloys or stainless steel, PEEK or PLLA, or otherbiocompatible and/or bioabsorbable materials known in the art.

FIG. 10 illustrates button 101 of the system 100 having a circular ordisc-shaped configuration. The button 101 is preferably formed fromtitanium or stainless steel although, as known to those skilled in theart, any other suitable material, in particular any suitablebioabsorbable materials, may be used. The button 101 also has at leasttwo flexible coupling-locating apertures 104. In the illustratedembodiment, there are four apertures 104 circumferentially arrangedabout the outer edge of the button. In the illustrated embodiment only,each of the apertures 104 has a diameter of about 1.0 mm. Each of theapertures 104 may have beveled edges, above and below, or only above, oronly below.

Flexible strand or continuous loop 110 extends between at least one ofthe apertures of the first button 101 and at least one of the aperturesof the second button 102. Flexible strand or continuous loop 110 may beformed of suture, for example a high strength suture material such asFiberWire® suture, sold by Arthrex, Inc. of Naples, Fla., and describedin U.S. Pat. No. 6,716,234, the disclosure of which is incorporated byreference herein. The high strength suture may be available in variouslengths and, preferably, is a #5 FiberWire® suture strand. FiberWire®suture is formed of an advanced, high-strength fiber material, namelyultrahigh molecular weight polyethylene (UHMWPE), sold under thetradenames Spectra (Honeywell) and Dyneema (DSM), braided with at leastone other fiber, natural or synthetic, to form lengths of suturematerial. The suture may optionally include filaments of various colors.The suture may be also formed of a plurality of suture strandsconfigured to separate from a single strand to a plurality of strands inthe continuous loop.

Various steps of methods of acromioclavicular joint reconstructionaccording to embodiments of the present invention are provided below,first with reference to specific steps, and second with reference tosteps relative to the structures illustrated in FIGS. 1-7.

Prior to undergoing acromioclavicular joint reconstruction, the patientis positioned in the beach chair or lateral decubitus position under ageneral anesthesia. Subsequently, the following actions may beundertaken: induce the arthroscope into the glenohumeral joint via astandard posterior portal; create an anterior/superior portal with anoutside/in technique using a spinal needle for position; insert a 7 mmPartially Threaded Cannula into this portal; create an anterior/inferiorportal near the tip of the coracoid, with an outside/in technique usingthe spinal needle to ensure that the base of the coracoid can bereached; insert an 8.25 mm Twist-In Cannula through this portal andstart the debridement of the rotator interval; and introduce a 4.5 mmfull radius shaver blade through the anterior/inferior cannula and intothe rotator interval and debride until the tip of the coracoid can bevisualized.

The following actions may be also performed: using a 70° arthroscope,release the middle glenohumeral ligament and partially release themiddle glenohumeral ligament; retract the anterior/inferior cannulabehind the rotator interval to completely reach the superior and middleglenohumeral ligaments; once the interval has been cleared, start toexpose the base of the coracoid using a mechanical shaver andradiofrequency device; move the arthroscope to the superior portal tofacilitate the view of the base of the coracoid; and strip the bursa andperiosteum from the base of the coracoid, to obtain a full view of theundersurface.

Particular exemplary steps of the reconstruction technique of thepresent invention will be explained below with reference to FIGS. 1-7:

Reference is now made to FIG. 1. Insert assembled Adapteur Drill GuideC-Ring with the Coracoid Drill Stop and Graduated Guide Pin Sleeve 88(FIG. 8) through the anterior/inferior portal. Position the drill stoptip under base 21 of the coracoid 20, as close to the scapula aspossible. Position the top of the Guide Pin Sleeve over the superiorclavicle 10 at its midline approximately 25 mm from the distal claviclethrough a 1.5 cm incision made in Langers lines by splitting thedeltotrapezial fascia.

Using a power drill, insert a drill guide pin 51 (for example, a 2.4 mmDrill Tip Guide Pin) into the guide pin sleeve and advance it throughthe clavicle 10 and coracoid 20. The tip of the guide pin is captured bythe drill stop at the base of the coracoid under direct visualization.Check the position of the pin 51 in relation to the coracoid and, ifincorrect, redrill the guide pin. Remove the C-Ring and leave the guidepin 51 in situ.

Reference is now made to FIG. 2. Attach the Coracoid Drill Stop to ahandle (for example, a Tear Drop handle), to hold the guide pin 51 inplace while drilling over it. Using a power drill, advance a drill 53(for example, a 4 mm Cannulated Drill) over the pin 51 and through theclavicle and coracoid to form two passages (tunnels or holes) 10 a, 20 a(FIG. 4). Cannulated drilling beyond the coracoid 20 should be avoidedunder direct arthroscopic visualization. Remove the guide pin 51 andleave the Cannulated Drill 53 in situ.

With reference to FIG. 3, advance a passing wire 55 (for example, aNitinol suture passing wire) down through the Cannulated Drill 53 andgrasp the tip with the arthroscopic grasper. Remove the drill 53 priorto delivering the wire tip out of the anterior/inferior portal, leavingwire loop 55 a superiorly.

Referring to FIG. 4, insert at least one traction suture 102 a (forexample, two white traction sutures) from the oblong button 102 of thereconstruction system 100 (FIG. 8) through the wire loop 55 a of theNitinol suture passing wire 55.

Reference is now made to FIG. 5. Pull the suture passing wire 55 toretrieve the two white traction sutures 102 a out of theanterior/inferior cannula. Pull on one of the two white traction sutures102 a to flip the oblong button 102 into a vertical position suitablefor advancement through the bone tunnels 10 a, 20 a.

Referring to FIG. 6, advance the oblong button 102 through the bonetunnels 10 a, 20 a in the clavicle 10 and the coracoid 20 under directvisualization, until it exits the coracoid base 21. Independently pullon each of the white traction sutures 102 a of the oblong button 102, toflip the button 102 onto the underside of the coracoid base 21.

Once the security of the oblong button 102 is confirmed, place thearthroscope into the subacromial bursa through the posterior portal(FIG. 7). Reduce the clavicle 10 until the position is felt to besatisfactory under direct visualization. Pull on suture tails 101 a (forexample, two blue suture tails) of the round button 101, to advance theround button 101 down to the surface of the clavicle 10. Tie the suturesover the top of the fixation system 100 (TightRope) making, for example,a surgeon's knot and two reverse half-hitches. This step completes thereduction and stabilization of the acromioclavicular joint 99. Thesuture tails can be sewn under the deltotrapezial fascia to minimize theknot stack. Remove any remaining white traction sutures by cutting andputting them out of the buttons. Fluoroscopy may be used at this stageto confirm reduction.

Although the above embodiments have been described with reference to anacromioclavicular joint reconstruction, the invention is not limited tothis embodiment. Accordingly, the present invention also contemplatesother kinds of joint and ligament reconstructions, the acromioclavicularjoint reconstruction being just illustrative.

Although the present invention has been described in relation toparticular embodiments thereof, many other variations and modificationsand other uses will become apparent to those skilled in the art.Accordingly, it is not intended that the present invention be limited tothe illustrated embodiments, but only by the appended claims.

1. A fixation system for internal fixation of a joint dislocation,comprising: a first fixation device having a first body with a firstconfiguration and provided with a plurality of first apertures; a secondfixation device having a second body with a second configuration andprovided with a plurality of second apertures; and a flexible membermountable, in use, between the first and second fixation devices.
 2. Thefixation system of claim 1, wherein at least one of the first and secondfixation devices is a button.
 3. The fixation system of claim 1, whereinthe first fixation device is a button with four apertures and the secondfixation device is a button with two apertures.
 4. The fixation systemof claim 1, wherein the first configuration is different from the secondconfiguration.
 5. The fixation system of claim 1, wherein the firstconfiguration is similar to the second configuration.
 6. The fixationsystem of claim 1, wherein the first fixation device is a circularbutton and the second fixation device is an oblong button.
 7. Thefixation system of claim 1, wherein the flexible member is suture. 8.The fixation system of claim 1, wherein the flexible member isFiberWire.
 9. The fixation system of claim 1, wherein the jointdislocation is acromioclavicular joint dislocation of the shoulder. 10.A button/suture construct, comprising: a first button having a circularconfiguration; a second button having an oblong configuration; and asuture strand between the first and second buttons, the suture strandbeing double looped through the first and second buttons.
 11. Thebutton/suture construct of claim 10, wherein the suture strand is fed,in use, through at least a first opening of the first button and throughat least a second opening of the second button.
 12. The button/sutureconstruct of claim 10, wherein the first button and the second buttonare adapted for engagement in or on the clavicle and the coracoid,respectively.
 13. The button/suture construct of claim 10, wherein atleast one of the first and second buttons has a length of about 9 toabout 20 mm.
 14. The button/suture construct of claim 10, wherein atleast one of the first and second buttons has a width of about 2 toabout 3 mm.
 15. The button/suture construct of claim 10, wherein atleast one of the first and second buttons is formed of a metal or ametal alloy.
 16. The button/suture construct of claim 10, wherein atleast one of the first button and the second button is formed of amaterial selected from the group consisting of metals, metal alloys,PEEK and PLLA.
 17. The button/suture construct of claim 10, wherein thesuture strand has a suture portion provided between the first button andthe second button.
 18. The button/suture construct of claim 17, whereinthe suture portion has a length which is about equal to the length ofthe acromioclavicular joint.
 19. A method for internal fixation ofacromioclavicular joint dislocations, comprising the steps of: providingan internal fixation device comprising a first member with a firstconfiguration and provided with a plurality of first apertures; a secondmember with a second configuration and provided with a plurality ofsecond apertures; and a flexible coupling between the first and secondmembers, the flexible coupling being looped through the plurality offirst and second apertures; securing the first and second members on oradjacent to the clavicle and the coracoid, respectively; and reducingthe distance between the clavicle and the coracoid.
 20. The method ofclaim 19 further comprising the steps of: forming a first hole throughthe clavicle and a second hole through the coracoid; advancing one ofthe first and second members through the first and second holes, so atto exit the coracoid as an exited member; pivoting the exited member toengage a surface of the coracoid; engaging the other of the first andsecond members to a surface of the clavicle; and reducing the distancebetween the clavicle and the coracoid by traction of the flexiblecoupling.
 21. The method of claim 19, wherein the first member is abutton with a circular body and circular apertures, and the secondmember is a button with an oblong body and oblong apertures.
 22. Themethod of claim 19, wherein the flexible coupling is a high strengthsuture.